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Permit No. 4093 ri ! ! CITY OF CHINO HILLS APPLICATION FOR A BUILDING PERMIT AND COMMUNITY DEVELOPMENT A CERTIFICATE OF USE &OCCUPANCY 2001 Grand Avenue .n i. Chino Hills, CA 91709 BUILDING _ PROPOSED USE W ADDRESS abs , Ili Sir, pa.S OI-. �r• '�tt (�}1 ("`p CF APN S CR" v..A'T Po c'e,I O I 030--56- fir = THE FOLLOWING WORK IS AUTHORIZED BY THIS PERMIT > LOT / (`/ BLOCK TRACT 13504 rJ STRUCT A_PLUMB Ifp MECH CD.ELECT Ire-GRADING 0 CoS FR TYPE OF PERMIT O NEW 0 ALTER 0 ADDITION en APPLICANT BS�ac,�C 1'kovintV "\ en N 0 REPAIR 0 CONVERT 0 DEMO 0 OCCUPANCY PMT ADDRESS g3ma y\ RA t�� utak/ ‘ sait. i3 v{ ) DESCRIPTION I LOCATION PROPERTY ON I IZE FEET CITYl ..., vvL�/Ltil`a Cll)}S{Tt rep6S� PH l03•'tU61 T I S� I IO2-U LK'1 (� Jf � [[vv �/ OWNER �«4yc AS Abriie 2 Vit tic I ( .Ar R� ADDRESS qy 9 3 Net\0 / CITY ZIP PH I d ARCHITECT ENGINEER i_ C,, (lfVOOR„3 LIC NO REMARKS/SPECIAL CONDITIONS/PROJECT DESCRIPTION y ADDRESS/53—/ t. �-10 /LVn.tY NO STORIES NO DWELLING UNITS BEDROOMS y CITY 94614 Anil VP9)3/3 PH citt" ROOF I INT WALL '�I CONTRACTOR GI nn- LIC NO I FLOOR ! EXT WALL I ID ADDRESS CEILING HEATING I METAL FIREPLACE MASONRY CITY ZIP PH SEWER I MIN DEPTH S/F/100 I SIZE CITY BUSINESS LICENSE LICENSE NO EXPIRATION DATE LICENSED CONTRACTOR'S DECLARATION CUBIC YARDS EXCAVATION FILL OVER EXCAVATION I hereby affirm that I em licensed under provisions of Chapter B(commencing wtth Section 7000 of Division 3 of lbs Business and Professions Coda,and tmfy/lice+nsse is In full force and elfecl License Class t? I License Number 54164 cIi1 .l 2 CR. Date Contractor ADDRESS CITY AND ZIP PHONE OWNER-BUILDING DECLARATION I hereby affirm that I am exempt from the Contractor•License Law for the following reason O i as owner at the property,or my employees with wages as their sole oompensabon wilt do the work and the structure is not intended or altered for sale O I as owner of the property amaxciuswely contracting with licensed contractors(*construct the proper ZONING I \ � LAND USE ❑ I am exempt under Sec BYF- tan &PC for s reason I I Dale INITIAI SETBACKS I MODEL/PLAN WORKERS MENSATION CO I hereby affirm that I have a certificateoP consent to self insure or a cerldluN of Worsen FY ' SY Compensation Insurance�,vo�r�a certified copy thereof RY I SSY COMPANY /VPI' 4 5 POLICY NO vs;at,/3g o)t{n7: GROUP DIVISION kit y�❑ Certified copy is hereby furnished DATE EXPIRES tVAI`rt Ivl Certifi1ed copy nis filed with the any CITY VERIF ED 'nay,.'' / VALUATION I ling 1 Dale !..' �J� APPLICANT I'"^✓ tt ln•'L( ling -_ i JI PERMIT FEES CERTIFICATE OF EXEMPTION FROM WORKERS COMPENSATION INStAANCE [' I certify that in performance of the work for which the pound a Issued I shall not employ any ELECTRICAL 0o $y I STRUCTURAL f�`�f j. t i person in any nunner so as to become subject to the Workers'Compensation Law of California c,�J�,J _r •T Dale APPLICANT Q(0.°'D I GRADING 3' NOTICE TO APPLICANT If,after making the Comfiest*of Exemption you should become coif subpci to the Workers Compensation provisions of the Labor Code,you must forthwith comply J with such provisions or this perms shell be deemed revoked MECHANICAL 63 g. I ISSUANCE FEES Q5' I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMA TION IS CORRECT I AGREE TO COMPLY WITH ALL CITY ORDINANCES AND STATE LAWS, GEO REVIEW I PLAN CHECK Cc 3"3 AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS CITY TO ENTER UPON THE ABOVE .,J J MENTIONED PROPERTY FOR INSPECTION PURPOSES //cam /-3t-Ts ISSUANCE AP TOTAL�PERMIT 7�FAE�}E Y�(�•/ slpnUpre of ApPlWani AtNY peOJ Dale A/JJYYs.+`-a" 15y 73! tV! DATE OFANC I PERI+ NUMB�3 1 / d Name ID Pont Applicant:Agent a Name 1 FINANCE CODE a Lt 1 I i Operator: DAMN Check 0: 000000000 WHITE- FILE/GREEN- FINANCE/YELLOW• OFFICE 1 PINK• OWNER CHECK $11Ee. e!41/5 40 Receipt is 563 CH5671.3.33 GOLD-ASSESSOR/MANILA • INSPECTOR 4 aunt Tendered $1567.33 •ONSTRUCTION LENDING AGENC• I HEREBY AFFIRM THAT THERE IS A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED (SEC 3097,CIV C) LENDER'S NAME LENDER S ADORCC".... _ -. DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION THE CALIFORNIA HEALTH AND SAFETY CODE REQUIRES A DIVISION OF INDUSTRIAL SAFETY PERMIT AS A PREREQUISITE TO PERMIT ISSUANCE UNLESS THE APPLICANT SIGNS ONE OF THE CERTIFICATES BELOW O I CERTIFY THAT NO EXCAVATION 5 FEET OR MORE FEET IN DEPTH,INTO WHICH A PERSON IS REQUIRED TO DESCEND,WILL BE MADE IN CONNECTION WITH WORK AUTHORIZED BY THIS PERMIT,AND THAT NO BUILDING.STRUCTURE,SCAFFOLDING,FALSEWORK,OR DEMOLITION OR DISMANTLING THEREOF,WILL BE MORE THAN 38 FEET HIGH O AS OWNER/BUILDER I WILL NOT EMPLOY ANYONE TO DO WORK WHICH WOULD REQUIRE A PERMIT FROM THE DIVISION OF INDUSTRIAL SAFETY,AS NOTED ABOVE UNLESS SUCH PERSON HAS A PERMIT FROM THAT DIVISION DIVISION OF INDUSTRIAL SAFETY PERMIT NUMBER I HAVE READ THE HAZARDOUS MATERIALS QUESTIONNAIRE AND THE WORK APPLIED FOR ON THIS PERMIT DIS 01$NOT SUBJECT TO THE APPLICABLE REQUIREMENTS OF THE HEALTH AND SAFETY CODE AND THE LOCAL AIR QUALITY AGENCY • • f . .. Y r 0-1-9.4('N.4 r -"ear fa - .yy ,Y�P"`Y'kCf i0.V 2.;��.w. -- "'..• -'a: - ,.a: e+}(YigS•, T I / -..+?•> CITY OF CHINO HILLSAPPLICATION FOR A BUILDING PERMIT AND -irk• A CERTIFICATE OF USE &OCCUPANCY „? COMMUNITY DEVELOPMENT • t.-. 2001 Grand Avenue - ; .� ., Chino Hills, CA 91709 BUILDING S 2072 t/ 1 i 5-k,4 D� ^ _ C PROPOSED USE ADDRESS L/. y� ~�ll/JJY CO APN C. 0 1 Z ) L " THE FOLLOWING WORK IS AUTHORIZED BY THIS PERMIT LOT BLOCK TRACT 0 STRUCT 0 PLUMB r0 MECH 0 ELECT 0 GRADING 0 I/ S I y TYPE OF PERMITNEW 0 ALTER 0 ADDITION A APPLICANT I n I 0 REPAIR 0 CONVERT 0 DEMO 0 OCCUPANCY PMT ADDRESS i PROJECT I LOCATION ON I SIZE 4 DESCRIPTION PROPERTY IN SO FEET CITY ZIP 1 PH et l y I I I Q OWNER 2 II ADDRESS CITY ZIP PH 4 ARCHITECT ENGINEER , ( • I LIC NO REMARKS/SPECIAL CONDITIONS/PROJECT DESCRIPTION i ADDRESS - NO STORIES NO DWELLING UNITS BEDROOMS r f , • CITY ZIP r PH ROOF I FLOOR EXT WALL INT WALL CONTRACTOR LIC NO l ADDRESS - CEILING HEATING I FIREPLACE METAL MASONRY et CITY ZIP PH SEWER MIN DEPTH S/F/100 I SIZE CITY BUSINESS LICENSE LICENSE NO EXPIRATION DATE LICENSED CONTRACTOR'S DECLARATION CUBIC YARDS EXCAVATION FILL OVER EXCAVATION I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000 •••4-4-- ol Division 3 of the Business and Professions Code,and my license is in full force and effect Lrcense Class License Number i , - Dale contractor ADDRRee CITY AND ZIP PHONE OWNER-BUILDING DECLARATION I hereby affirm that I am exempt from the Contractors License Law for the following reason O I as owner of the property or my employees with wages as their sole compensation,will do the work,end the structure Is not intended or offered for sale ❑ I as owner of the property am exclusively contracting with licensed contractors to construct the propel ZONING I LAND USE ❑ I em exempt under Sec B8PC for this reason I ` x Oat., INITIAI SETBACKS I MODEL/PLAN WORKERS COMPENSATION DECLARATION FY I SY I I hereby affirm that I have a certificate of consent to self insure,or a certificate of Workers' Compensation Insurance ora certified copy thereof RY I SSY I COMPANY POLICY NO GROUP DIVISION TYPE I, -- t./'- O Certified copy is hereby furnished DATE EXPIRES O Certified copy is filed with the city CITY VERIFIED VALUATION . H •t! I Date APPLICANT PERMIT FEES CERTIFICATE OF EXEMPTION FROM WORKERS COMPENSATION INSURANCE I certify that in performance of the work for which this permit is issued I shall not employ any ELECTRICALI STRUCTURAL person in any manner so to become subject to the Workers Compensation Law of California as •i Dal- APPLICANT 4.e PLUMBING GRADING NOTICE TO APPLICANT II,after making this Certificate of Exemption you should become r subtect to the Workers Compensation provisions of the Labor Code,you must forthwith comply with such provisions or this permit shall be deemed revoked MECHANICAL - ISSUANCE FEES I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMA TION IS CORRECT 1 AGREE TO COMPLY WITH ALL CITY ORDINANCES AND STATE LAWS, GEO REVIEW PLAN CHECK (_ AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS CITY TO ENTER UPON THE ABOVE . MENTIONED PROPERTY FOR INSPECTION PURPOSES ISSUANCE APPROVED TOTAL PERMIT FEE Signature of Applicant or Agent Date i s l v' t in, r DATE OF ISSUANCE PERMIT NUMBER Pnnt Applicant s/Agent s Name "- I I 1 ' 5 I y f FINANCE CODE ‘WHITE- FILE/GREEN• FINANCE/YELLOW- OFFICE/PINK- OWNER GOLD-ASSESSOR/MANILA -INSPECTOR •ONSTRUCTION LENDING AGENCS I HEREBY AFFIRM THAT THERE IS A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED (SEC 3007, CIV C) LENDER'S NAME LENDER'S ADDRrec DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION THE CALIFORNIA HEALTH AND SAFETY CODE REQUIRESA DIVISION OF INDUSTRIAL SAFETY PERMIT AS A PREREQUISITE TO PERMIT ISSUANCE UNLESS THE APPLICANT SIGNS ONE OF THE CERTIFICATES BELOW O I CERTIFY THAT NO EXCAVATION 5 FEET OR MORE FEET IN DEPTH,INTO WHICH APERSON IS REQUIRED TO DESCEND,WILL BE MADE IN CONNECTION WITH WORK AUTHORIZED BY THIS PERMIT,AND THAT NO BUILDING,STRUCTURE,SCAFFOLDING,FALSEWORK,OR DEMOLITION OR DISMANTLING THEREOF,WILL BE MORE THAN 36 FEET HIGH ❑ AS OWNER/BUILDER I WILL NOT EMPLOY ANYONE TO DO WORK WHICH WOULD REQUIRE A PERMIT FROM THE DIVISION OF INDUSTRIAL SAFETY,AS NOTED ABOVE UNLESS SUCH PERSON HAS A PERMIT FROM THAT DIVISION DIVISION OF INDUSTRIAL SAFETY PERMIT NUMBER I HAVE READ THE HAZARDOUS MATERIALS QUESTIONNAIRE AND THE WORK APPLIED FOR ON THIS PERMIT DIS ❑IS NOT SUBJECT TO THE APPLICABLE REQUIREMENTS OF THE HEALTH AND SAFETY CODE AND THE LOCAL AIR QUALITY AGENCY BUILDING INSPECTIONS RECORD DATE I INSPECTOR DATE I INSPECTOR Setback/Location I Rough Plumbing ,./ kr I ,...G Temporary Power I Shower Pan Test � Foundation Reinforcing Steel I Stucco Mesh or Exterior Siding 7/c.r/fr - Excavation and Forms I Insulation y/Lo/y-f Slab Grade /y/9/¢'! Sewer G/7�Ss Ground Plumbing Soil f/3//yam flaa Interceptor Ground Plumbing Water 6/9/5-C— i/5/ Septic Tank Underslab Ducts Leach Line or Seep Pit Underslab Conduit Water Service7//j/TS 034:7<- Underslab /yrUnderslab Gas Lath or Drywall Nailing 7/2 s1/4-3—. 6r41 Fireplace Foundation Gas Line Air Test p///iyr Joists and Girders Final Energy Electrical Ground /v/S'/if Final Plumbing 9/��r1s— ase. Mid-Height Bond Beam Final Heating/A C c3/y,/o,� 8-Foot Bond Beam Final Construction I//et,/ / ' Final Bond Beam Final On Site Improvements Fireplace Bond Beam Final Off Site Improvements Roof Sheathing € SH<a-y 7/S/Ff ,.,� Final Dedication Framing and Ventilation 7/zo/yam Final Zoning Roof Covering - Final Electrical a/o/q Rough Heating 7/2-o/jS ,4ZX Final Gas 7� o/ / Service and Ground \ \ Developer Fees Paid Rough Electrical / / Fire Dept Approval Verified Bonding 77z0/pr ��� Certificate of Occupancy Over Head Electrical Fence Height Gates Heater Pool Drainage -Ph Yr"- Cas--47: 6v.>, tip SEPTIC TANK GALS SEEP PIT X LEACH LINE WIDF LONG X DEPTH OF ROCK N W E Inspector's Signature and Initials DATE Ij ISSLAANCE/ PERMIT NUMBER